Association of Demographic and Socioeconomic Indicators With the Use of Wearable Devices Among Children
Authors: Ethan H. Kim, Jessica L. Jenness, Adam Bryant Miller, Ramzi Halabi, Massimiliano de Zambotti, Kara S. Bagot, Fiona C. Baker, Abhishek Pratap
Journal: JAMA Network Open (2023)

Importance The use of consumer-grade wearable devices for collecting data for biomedical research may be associated with social determinants of health (SDoHs) linked to people’s understanding of and willingness to join and remain engaged in remote health studies. Objective To examine whether demographic and socioeconomic indicators are associated with willingness to join a wearable device study and adherence to wearable data collection in children. Design, Setting, and Participants This cohort study used wearable device usage data collected from 10 414 participants (aged 11-13 years) at the year-2 follow-up (2018-2020) of the ongoing Adolescent Brain and Cognitive Development (ABCD) Study, performed at 21 sites across the United States. Data were analyzed from November 2021 to July 2022. Main Outcomes and Measures The 2 primary outcomes were (1) participant retention in the wearable device substudy and (2) total device wear time during the 21-day observation period. Associations between the primary end points and sociodemographic and economic indicators were examined. Results The mean (SD) age of the 10 414 participants was 12.00 (0.72) years, with 5444 (52.3%) male participants. Overall, 1424 participants (13.7%) were Black; 2048 (19.7%), Hispanic; and 5615 (53.9%) White. Substantial differences were observed between the cohort that participated and shared wearable device data (wearable device cohort [WDC]; 7424 participants [71.3%]) compared with those who did not participate or share data (no wearable device cohort [NWDC]; 2900 participants [28.7%]). Black children were significantly underrepresented (−59%) in the WDC (847 [11.4%]) compared with the NWDC (577 [19.3%]; P &amp;amp;lt; .001). In contrast, White children were overrepresented (+132%) in the WDC (4301 [57.9%]) vs the NWDC (1314 [43.9%]; P &amp;amp;lt; .001). Children from low-income households (&amp;amp;lt;$24 999) were significantly underrepresented in WDC (638 [8.6%]) compared with NWDC (492 [16.5%]; P &amp;amp;lt; .001). Overall, Black children were retained for a substantially shorter duration (16 days; 95% CI, 14-17 days) compared with White children (21 days; 95% CI, 21-21 days; P &amp;amp;lt; .001) in the wearable device substudy. In addition, total device wear time during the observation was notably different between Black vs White children (β = −43.00 hours; 95% CI, −55.11 to −30.88 hours; P &amp;amp;lt; .001). Conclusions and Relevance In this cohort study, large-scale wearable device data collected from children showed considerable differences between White and Black children in terms of enrollment and daily wear time. While wearable devices provide an opportunity for real-time, high-frequency contextual monitoring of individuals’ health, future studies should account for and address considerable representational bias in wearable data collection associated with demographic and SDoH factors.